心脏瓣膜置换术后患者Ⅰ期心脏康复的最佳证据总结

doi:10.16460/j.issn1008-9969.2019.18.032

摘要/Abstract

摘要： 目的检索和获取国内外心脏瓣膜置换术后患者Ⅰ期心脏康复的最佳证据,为医护人员、管理者、患者进行Ⅰ期心脏康复临床实践提供参考。方法用PIPOST模式构建循证问题,制定严密的检索策略和纳入排除标准,系统检索心脏瓣膜置换术后患者Ⅰ期心脏康复的相关证据,从中筛选出符合纳入标准的文献。由2名有资质的研究者对纳入的文献采用对应的评价工具独立进行质量评价、证据提取和综合。结果共纳入9篇文献,其中3篇指南、1篇系统评价、3篇随机对照试验研究、1篇类实验研究和1篇专家共识。从9篇文献中共提取20条证据,综合成5个维度,17条最佳证据,分别为评估、综合呼吸功能训练、阶段性运动训练、运动观察和健康教育。结论护理管理者需加强护理人员心脏康复知识的培训,并结合医疗机构的临床环境、护理人员的专业判断、患者意愿等有针对性的选择证据。

关键词: 心脏瓣膜病, 心脏康复, 院内康复, 最佳证据, 循证护理

Abstract: Objective To summarize the best evidence of cardiac rehabilitation of patients after heart valve replacement and to provide reference for domestic cardiac rehabilitation. Methods With questions developed by PIPOST, a rigorous search strategy, inclusion criteria and exclusion criteria were developed, we searched original research for evidence of cardiac rehabilitation in adult patients after heart valve replacement, and extracted the evidence of the literatures meeting the quality standards. Two researchers used the corresponding evaluation tools to conduct quality evaluation, evidence extraction and synthesis independently. Results Nine studies were found, including three clinical practice guidelines, one systematic review, three RCTs, one CCT and one consensus. Totally 20 items of evidence were summarized and five dimensions including assessment, comprehensive respiratory function training, periodic sport training, sport observation and health education and 17 items of best evidence were extracted. Conclusion Nursing administrators should strengthen education on cardiac rehabilitation among nurses,when choosing the best evidence, clinical environment, professional judgment of nurses and patients' willingness should be taken into consideration.

Key words: heart valve disease, cardiac rehabilitation, hospital rehabilitation, best evidence, evidence-based nursing

中图分类号:

R473.54

何文斌, 廖尧, 尹熙, 杨茜, 胡君娥, 严妍, 周雪果, 姚小云, 陈红宇. 心脏瓣膜置换术后患者Ⅰ期心脏康复的最佳证据总结[J]. 护理学报, 2019, 26(18): 32-36.

HE Wen-bin, LIAO Raon, YIN Xi, YANG Qian, HU Jun'e, YAN Yan, ZHOU Xue-guo, YAO Xiao-yun, CHEN Hong-yu. Evidence Summary for Cardiac Rehabilitation in Patients after Cardiac Valve Replacement[J]. Journal of Nursing, 2019, 26(18): 32-36.

参考文献

[1] 于晋,蒋洪宇,黄保堂,等.老年退行性心脏瓣膜病患者手术危险因素及治疗分析[J].广西医科大学报, 2016,33(4):720-722.DOI:10.16190/j.cnki.45-1211/r.2016.04.048.
[2] Sibilitz K L, Berg S K, Rasmussen T B, et al.Cardiac Rehabilitation Increases Physical Capacity but Not Mental Health after Heart Valve Surgery: A Randomised Clinical Trial[J].Heart,2016,102(24):1995-2003.DOI:10.1136/heartjnl-2016-309414.
[3] 高佳斌. 老年心脏瓣膜病外科治疗分析[D].上海:第二军医大学,2016.
[4] Hansen T B, Zwisler A D, Berg S K, et al.Cardiac Rehabilitation Patients’ Perspectives on the Recovery Following Heart Valve Surgery:A Narrative Analysis[J]. J Adv Nurs,2016,72(5):1097-1098.DOI:10.1111/jan.12904.
[5] Furukawa H, Kangai K, Minami K, et al.Initial Clinical Experience of Early Cardiac Rehabilitation for Very Elderly Patients Over 85 Years Old Following Open Heart Surgery[J].Kyobu Geka,2012,65(6):440-445.
[6] 陈文彬,程德云.呼吸系统疾病诊疗技术[M].北京:人民卫生出版社,2000:370-376.
[7] Brown R A.Rehabilitation of Patients with Cardiavascular Diseases Report of a WHO Expert Committe[J].World Health Organ Tech Rep Ser,1964,270(1):3-46.
[8] 高炜. 普及和推广心脏康复理念,积极探索适宜的心血管疾病康复模式[J].中国医学前沿杂志(电子版),2013,5(9):1-5.DOI:10.3969/j.issn.1674-7372.2013.09.002.
[9] American Association of Cardiovascular and Pulmonary Rehabilitation.Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs[M].5th ed. Champaign,IL:Human Kinetics,2013.
[10] Murphy A.Guidelines for Cardiac Rehabilitation and Secondary Prevention Programmes[J]. Physiotherapy,2000,86(12):667.DOI:10.1016/S0031-9406(05)61310-7.
[11] 杨中善,许妮娜,詹昱新,等.住院患者规范化身体约束管理最佳证据总结[J].护理学报,2019, 26(4):36-41.DOI:10.16460/j.issn1008-9969.2019.04.031.
[12] Aromataris E, Fernandez R, Godfrey C M, et al.Summarizing Systematic Reviews: Methodological Development,Conduct and Reporting of an Umbrella Review Approach[J].Int J Evid Based Healthc, 2015, 13(3):132-140.DOI:10.1097/XEB.0000000000000055.
[13] The Joanna Briggs Institute.Joanna Briggs Institute Reviewer’Manual:2016 edition.Australia:The Joanna Briggs Institute[EB/OL].(2016-03-18)[2018-08-15].http://www.JoannaBriggs.org.
[14] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[15] Lynggaard V, Nielsen C V, Zwisler A D, et al.The Patient Education-learning and Coping Strategies-improves Adherence in Cardiac Rehabilitation(LC-REHAB): A Randomised Controlled tial[J]. Int J Cardiol,2017,2(51):6-11.DOI:10.1016/j.ijcard.2017.02.051.
[16] Clark I N, Baker F A, Peiris C L,et al.Participant-selected Music and Physical Activity in Older Adults Following Cardiac Rehabilitation: A Randomized Controlled Trial[J].Clin Rehabil,2017, 31(3):1-11.DOI:10.1177/0269215516640864.
[17] Aamot I, Karlsen T, Dalen H, et al.Long-term Exercise Adherence after High-intensity Interval Training in Cardiac Rehabilitation:A Randomized Study[J]. Physiother Res Int,2016,21(1):54-64.DOI:10.1002/pri.1619.Epub.2015.02.16.
[18] 练银霞,陈振强,叶生爱.心胸外科手术患者呼吸训练器呼吸功能锻炼效果[J].护理学杂志,2017,32(8):40-47.DOI:10.3870/j.issn.1001-4152.2017.08.040.
[19] Balraj S H, Jenny M H Chen, Shah Ebrahim, et al. Exercise-based Cardiac Rehabilitation for Corona-Y Heart Disease[J].Cochrane Database Syst Rev,2014,11(3):1-73.DOI:10.1002/14651858.
[20] 武亮,董继革,郭琪,等.中国社区心肺康复治疗技术专家共识[J].中国老年保健医学,2018,16(3):41-56.DOI:10.3969/j.issn.1672-2671.2018.03.012.
[21] Scottish Intercollegiate Guidelines Network.Cardiac Rehabilitation: A National Clinical Guideli-ne.Edinburgh:Scottish Intercollegiate Guidelines Network[EB/OL]. (2015-01-15)[2018-08-15].http://www.scotphn.net/wpcontent/uploads/2015/11/Cardiac_Rehabilitation.
[22] Herdy A H, Lopez-Jimenez F,Terzic C P,et al.South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation[J].Arq Bras Cardiol 2014,103(z Suppl1):1-31.DOI:10.5935/abc.2014S003.
[23] Japanese Circulation Society Joint Working Group. Guidelines for Rehabilitation in Patients with Cardiovascular Disease(JCS 2012)[J].Circ J, 2014, 78(8):2022-2093.DOI:10.1253/circj.CJ-66-0094.
[24] 杨满青,詹惠敏,刘智,等.阶段性康复护理在心脏瓣膜置换术后病人护理中的应用效果观察[J].护理研究,2018,32(12):1901-1903.DOI:10.12102/j.issn.100993.2018.12.019.
[25] Turner K M, Winder R, Campbell J L, et al.Patients’ and Nurses’ Views on Providing Psychological Support within Cardiac Rehabilitation Programmes: A Qualitative Study[J].BMJ Open,2017, 7(9):e017510.DOI:10.1136/bmjopen-2017-017510.
[26] 曹小翠,于红静,顾玉琴,等.心脏瓣膜病手术患者Ⅰ期心脏康复训练及护理[J].护理学报,2013,20(1):37-39.DOI:10.3969/j.issn.1008-9969.2013.01.014.
[27] 田丽清. 综合呼吸功能训练对心脏瓣膜置换术患者康复效果的评价[D].长沙:中南大学,2014.
[28] Ribeiro G S, Melo R D, Deresz, Luís F, et al.Cardiac Rehabilitation Programme after Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement: Systematic Review and Meta-analysis[J].Eur J Prev Cardiol,2017,24(7):688-697.DOI:10.1177/2047487316686442.
[29] Nici L, Donner C, Wouters E, et al.American Thoracic Society / European Respiratory Society Statement on Pulmonary Rehabilitation[J].Am J Respir Crit Care Med,2006(173):1390-1413.DOI:10.1164/rccm.200508-1211ST.
[30] Bridget A, Paul G, Tom B, et al.Exercise Training Characteristics in Cardiac Rehabilitation Programes:A Cross-Sectional Survey of Australian Practice[J]. Open Heart,2016,3(1):e000374.DOI:10.1136/openhrt-2015-000374.
[31] 陶香君,吴瑛,张艳.心内科护士主动开展急性心肌梗死患者早期心脏康复的意愿及影响因素分析[J].护理学报,2015, 22(22):35-39.DOI:10.16460/j.issn1008-9969.2015.22.035.
[32] Thomas R J.AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services[J].J Am Coll Cardio,2007,50(14):1400.DOI:10.1016/j.jacc.2007.04.033.

相关文章 15

[1]	张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47.
[2]	李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55.
[3]	杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[4]	刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55.
[5]	闫亚铃, 乐美妮, 姚桃琴, 王雪莲, 姜建玲, 辛艺. 老年胃肠肿瘤患者围手术期衰弱管理方案的构建[J]. 护理学报, 2025, 32(2): 74-78.
[6]	毕雅昕, 端烨, 何丽君, 徐秒, 龚荣花. 减重代谢术后骨质疏松症预防与管理的最佳证据总结[J]. 护理学报, 2025, 32(1): 44-49.
[7]	陈洁, 孟庆童, 刘惊今, 吴艳妮. 基于指南的慢性心力衰竭患者运动康复科普手册研制[J]. 护理学报, 2024, 31(9): 36-41.
[8]	符路路, 解艺璇, 王玥, 魏巍, 张传英, 朱宇. 新生儿操作性疼痛听觉刺激干预的证据总结[J]. 护理学报, 2024, 31(9): 42-47.
[9]	纪锐婷, 林丹娜, 刘小成, 李婷婷, 谢映梅, 胡冰, 应文娟. 早产儿初乳口腔免疫疗法的最佳证据总结[J]. 护理学报, 2024, 31(8): 37-42.
[10]	张小莉, 杨鑫玉, 肖宇, 刘春燕, 张璐, 伍晓琴, 黄月霖, 傅静. 晚期癌症患者代理决策者安宁疗护决策后悔研究的范围综述[J]. 护理学报, 2024, 31(8): 49-54.
[11]	白雅萍, 施婧. 共享决策在心脏瓣膜病介入治疗患者中的应用研究进展[J]. 护理学报, 2024, 31(7): 32-35.
[12]	周毅峰, 杨继平, 胡正中, 袁浩. 肝癌切除手术患者目标导向性血糖监测的证据总结[J]. 护理学报, 2024, 31(7): 46-50.
[13]	莫选菊, 吴远, 张曼, 刘章来, 申铁梅. 共患慢性失眠症住院患者实施睡眠限制疗法的证据总结[J]. 护理学报, 2024, 31(6): 62-66.
[14]	杨建国, 何细飞, 鄢建军, 张梦, 杨纯子, 徐蓉, 王艳芳. 局部枸橼酸抗凝在连续性肾脏替代治疗中的应用及管理的最佳证据总结[J]. 护理学报, 2024, 31(4): 48-53.
[15]	刘璇, 蓝玉清, 李梦如, 王小惠, 钟雪梅, 周文. 住院老年性痴呆患者跌倒预防的最佳证据总结[J]. 护理学报, 2024, 31(4): 54-59.

Metrics

Viewed

Full text

Abstract

Cited

Shared